Wang Zhi-Cong, Chen Xi, Wu Yu-Xuan, Yang Ling, Wang Hong, Jiang Wei, Gao Bo, Liu Yue-Hong
Orthopaedic Centre of Deyang City;Department of Orthopaedics, People's Hospital of Deyang City, Deyang 618000, Sichuan, China.
Zhongguo Gu Shang. 2022 Apr 25;35(4):361-6. doi: 10.12200/j.issn.1003-0034.2022.04.012.
To investigate the relationship between preoperative waiting time and prognosis of elderly patients with hip fracture.
From January 2014 to December 2018, 333 elderly hip fracture patients undergoing surgery were retrospectively analyzed, including 104 males and 229 females, aged from 60 to 99 years with an average of (77.93±8.49) years, and 183 patients were femoral neck fracture, 150 patients were femoral intertrochanteric fracture. Among them, 269 patients (80.78%) had a clustered preoperative waiting time of 2 to 8 days, and then divided into within 4-day group(91 cases) and over 4-day group(242 cases) according to their preoperative waiting time. The survival situation was followed by telephone, and follow-up time started from fracture admission to the death event, or to the research deadline (December 31, 2019). The Kaplan-Meier method was used for survival analysis, and Cox risk proportion model was used to analyze the independent risk factors of hip fracture in elderly patients.
All patients were followed up for 12 to 75 months(means 35 months), 59 patients died and the mortality rate was 17.72%(59/333). Compared with within 4-day group, the mortality rate was higher in over 4-day group[20.66%(50/242) vs. 9.89%(9/91), =5.263, =0.022]. Multiariable Cox regression analysis showed that preoperative waiting time, age, male and Charlson comorbidity index were independent risk factors for the prognosis of hip fracture in elderly patients (all <0.05), and every 1-day delay was associated with 5% increase of the risk of death[=1.05, 95%(1.00-1.10), =0.045]. Subsequent analyse was stratified according to the Charlson comorbidity index (CCI), and found that over 4-day group had a higher mortality rate in patients with CCI<2, with statistically significant difference(<0.05).
For elderly patients with hip fracture, most of hospitals could not complete the hip fracture surgery within 48 hours, we also need to shorten the waiting time before surgery, and thereby improve their prognosis.
探讨老年髋部骨折患者术前等待时间与预后的关系。
回顾性分析2014年1月至2018年12月期间333例接受手术的老年髋部骨折患者，其中男性104例，女性229例，年龄60～99岁，平均（77.93±8.49）岁；股骨颈骨折183例，股骨转子间骨折150例。其中269例（80.78%）患者术前等待时间集中在2～8天，再根据术前等待时间将其分为4天内组（91例）和4天以上组（242例）。通过电话随访生存情况，随访时间从骨折入院至死亡事件，或至研究截止日期（2019年12月31日）。采用Kaplan-Meier法进行生存分析，Cox风险比例模型分析老年髋部骨折患者的独立危险因素。
所有患者随访12～75个月（平均35个月），59例死亡，死亡率为17.72%（59/333）。与4天内组相比，4天以上组死亡率更高[20.66%（50/242）对9.89%（9/91），χ²=5.263，P=0.022]。多因素Cox回归分析显示，术前等待时间、年龄、男性及Charlson合并症指数是老年髋部骨折患者预后的独立危险因素（均P<0.05），每延迟1天死亡风险增加5%[HR=1.05, 95%CI(1.00-1.10), P=0.045]。随后根据Charlson合并症指数（CCI）进行分层分析，发现CCI<2的患者中4天以上组死亡率更高，差异有统计学意义（P<0.05）。
对于老年髋部骨折患者，多数医院无法在48小时内完成髋部骨折手术，仍需缩短术前等待时间，从而改善其预后。
